PRE-ANALYTICAL

• The pre-analytical testing phase includes procedures such as laboratory handling and identification, which take place prior to any laboratory testing.
• The laboratory test is used by physicians to diagnose and monitor the presence of a disease.

  The physicians compare the results to a reference range or reference interval.

  • This range shows the high and low limits of result values as compared to healthy individuals.
• Basal state is ideal in establishing reference range since it represents the condition of the metabolism of the body early in the morning or after approximately 12 hours of fasting.

  •This can be influenced by age, gender, and conditions of the body.
• Problem Areas to Avoid and Troubleshooting in the Site Selection

  • 1. Burns, Scars, and Tattoos - It is not advisable to choose a site that has burns, scars, or tattoos because veins in the area may be difficult to examine and blood circulation may be impaired.
• Problem Areas to Avoid and Troubleshooting in the Site Selection

  2. Damaged Veins - Aside from being difficult to perform, puncturing damaged veins may also produce inaccurate results. Veins could be sclerosed or hardened or thrombosed or clotted.
• Problem Areas to Avoid and Troubleshooting in the Site Selection

  3. Edema - also known as oedema, is an abnormal swelling caused by the accumulation of fluid in the tissues.

  • The tissues become fragile, making the task of locating the veins harder.
  • This condition may be due to reactions from medications, pregnancy, infections, and other medical problems.
• Problem Areas to Avoid and Troubleshooting in the Site Selection

  4. Hematoma - solid swelling or mass of blood in the tissues caused by the leakage of blood from the vessels during venipuncture. Selecting a venipuncture site with hematoma will be painful for the patient because it will obstruct the blood flow.
• Problem Areas to Avoid and Troubleshooting in the Site Selection

  5. Mastectomy - This procedure, often done to breast cancer patients, refers to the removal of the breast through surgery.

  • Blood drawing from patients who had undergone this procedure becomes a challenge since the lymph flow is obstructed, and there may be swelling and infection after the surgery.

  • In addition, tourniquet cannot be applied because it can cause injury. It could also change the blood composition.
• Problem Areas to Avoid and Troubleshooting in the Site Selection

  6. Obesity - This is the condition in which the individual is grossly overweight. Patients who are obese have veins that are deep and difficult to locate.

  A solution is using a longer tourniquet or locating the cephalic or cubital vein.
• Vascular Access Devices (VADs) are needed for blood sampling, infusing medication, central venous pressure readings, and blood transfusion of a patient.

  • Choosing vascular access sites is based on the needs of the patient, the purpose, and the length of time the device is to remain in the body.
• Listed are vascular access sites and devices used in phlebotomy

  • Arterial Line - To obtain samples for arterial blood gas and laboratory studies, critically ill patients require arterial lines where a thin catheter is inserted into an artery.
  • This is also used to monitor blood pressure continuously. Neither tourniquet nor venipuncture is allowed in the arm with an arterial line.
• Listed are vascular access sites and devices used in phlebotomy

  • Arteriovenous Shunt or Fistula - An arteriovenous shunt or fistula is a passageway created through surgery, and is usually in the arms with the intention of connecting the artery and a vein directly.
  • This may be created for hemodialysis treatment or pathological process such as erosion of arterial aneurysm.
• Listed are vascular access sites and devices used in phlebotomy

  3. Blood-sampling Device -used to avoid the use of needle- sticks, prevent infections, and reduce wastage from line draws.catheter where it is connected.

  The device collects blood from the arterial or central venous
• Listed are vascular access sites and devices used in phlebotomy

  4. heparin or saline lock - commonly called a "hep-lock, is intravenous (IV) catheter attached to a stopcock or cap with diaphragm.

  • Its basic function is to provide access for administering medicine or drawing blood from the patient. It is threaded in the peripheral vein, which is in the lower arm above the wrist for upon 48 hours.
  • It is usually flushed with heparin or saline (to prevent clogging) and capped for future use.
• Listed are vascular access sites and devices used in phlebotomy

  5. Intravenous (IV) Sites - An VI line is a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream. The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with IV fluid.

  • If blood collection is necessary, the collection site should be below the IV.
  • Take note that collection of blood from previously known IV sites should be avoided for 24 to 48 hours.
• Listed are vascular access sites and devices used in phlebotomy

  6. central vascular access devices (CADs) - also knownas indwelling lines, are any of the tubings inserted to the main vein or artery used for blood collection, monitoring the patient's pressures, and administering medications and fluids.
• There are three (3) types of CADs: the central venous catheter lines, the implanted port, and the peripherally inserted central catheter.
• 3 types of CADs

  1. Central venous catheter - is also known as a central lineSubclavian vein insertion inserted into the large vein (subclavian) and advanced into the superior vena cava.
• 3 types of CADs

  • Implanted port - is a surgically implanted disk-shaped chamber attached to the indwelling line. This is usually placed on the upper chest just below the collarbone.
• 3 types of CADs

  • Peripherally inserted central catheter (PICC) - is a flexible tube inserted into the veins of extremities and the central veins.